Sounds like capitation to me. Blue Cross & Blue Shield of Massachusetts is proposing to overhaul the way it pays doctors and hospitals. The plan wants to stop paying doctors and hospitals for each patient visit or treatment, and instead wants to pay a flat sum per patient each year. The fee would be adjusted for age and sickness, and would include a bonus if the providers improve care. . . . Updated rates of uninsured women categorized by state have just been issued by the Kaiser Family Foundation. The rates range from a high of 28 percent of women 18–64 (Texas) to a low of 9 percent (Minnesota). Among low-income women, in the same age group, the uninsured rate ranges from 51 percent (Texas) to 20 percent (Maine and Vermont). . . . The slowdown in health spending growth is not likely to last, according to a report issued by the Center for Studying Health System Change. Government economists report that personal health care spending — the portion of national health care spending that accounts for health care goods and services, grew 6.6 percent in 2006, just a hair below 2005’s 6.8 percent growth.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.